What should you do before your child starts taking an antidepressant?

It's important that your child have a thorough evaluation before he or she starts taking an antidepressant. A psychiatric evaluation by a psychiatrist, or a pediatrician or family doctor who is experienced in pediatric psychiatric issues, should include:

A detailed review of any potential risk factors your child may have that increase the risk of self-harm

An assessment of whether your child may have other mental illnesses, such as anxiety disorders, attention-deficit/hyperactivity disorder or bipolar disorder

An evaluation of whether there's a family history of mental illnesses or suicide

What antidepressants can children take?

The FDA approved two antidepressants for the treatment of depression in children and teenagers — fluoxetine (Prozac) for age 8 or older, and escitalopram (Lexapro) for age 12 or older. Fluoxetine is also FDA approved to treat obsessive-compulsive disorder (OCD) in children, as are the antidepressants sertraline (Zoloft), fluvoxamine (Luvox) and clomipramine (Anafranil).

Doctors may use their medical judgment to prescribe other antidepressants for children, such as citalopram (Celexa), for what's called off-label use. This is a clinically common practice for many types of medications for both children and adults.

Antidepressants come with a medication guide that advises parents and caregivers about risks and precautions. Be sure to carefully read the medication guide and package insert, and discuss any questions with your child's health care professionals.

What should you do once your child starts taking an antidepressant?

The FDA advises that doctors prescribe the smallest quantity of pills possible to help reduce the risk of deliberate or accidental overdose. Careful monitoring by parents, caregivers and health care professionals is important for any child or teenager taking an antidepressant for depression or any other condition.

The highest risk of suicidal thinking and behavior occurs:

During the first few months of treatment with an antidepressant

When the dosage is increased or decreased

Parents and caregivers should closely observe the child on a daily basis during these transition periods and watch for worrisome changes for the whole time the child takes antidepressants.

The FDA also recommends that your child receive close monitoring by his or her health care professional during the first few months of treatment. Frequency of contact with doctors or mental health professionals depends on your child's needs. Make sure you stick to your child's recommended appointment schedule.

What warning signs should you watch for when your child is taking antidepressants?

Sometimes the signs and symptoms of suicidal thoughts or self-harm are difficult to see, and your child may not directly tell you about such thoughts. Here are some signs that your child's condition may be worsening or that he or she may be at risk of self-harm:

Talk of suicide or dying

Attempts to commit suicide

Self-injury

Agitation or restlessness

Panic attacks

Increasing sadness

Extreme increase in talking or activity

Aggression, violence or hostility

New or worsening anxiety

Social or academic problems at school

Spending more time alone

Contact your child's health care professional right away if any of these signs occur, if they get worse, or if they worry you, your child, a teacher or other caregiver.

Don't stop antidepressant treatment without the guidance of your child's health care professional. Suddenly stopping an antidepressant may cause flu-like symptoms or side effects referred to as discontinuation syndrome.

What other treatment options are available for children with depression?

Most children who take antidepressants will improve with medication. However, combining medication with talk therapy (psychotherapy) is likely to be even more effective. Many types of therapy may be helpful, but cognitive behavioral therapy and interpersonal therapy have proved effective in the treatment of depression.

Cognitive behavioral therapy. In cognitive behavioral therapy, a mental health provider can help your child improve coping skills, communication and problem-solving skills. Your child can also learn how to become aware of harmful ideas and behaviors, replace them with positive approaches, and regulate emotions. This type of therapy can be effective with children and teenagers.

Interpersonal therapy. With a focus on relationships, this therapy may help your teenager adapt to changes in current relationships and develop new ones.

For some children and teenagers with mild symptoms, talk therapy alone may be beneficial.

Adegbite-Adeniyi C, et al. An update on antidepressant use and suicidality in pediatric depression. Expert Opinion on Pharmacotherapy. 2012;13;2119.

Antidepressant medications for children and adolescents: Information for parents and caregivers. The National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml. Accessed April 9, 2013.

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